Hundreds of millions of dollars worth of pledges poured in from round the world and Pakistani leaders said relief efforts were picking up speed, but few emergency supplies have reached desperate survivors because of the transport troubles. Some of the hardest-hit areas received their first aid on Tuesday as more helicopters joined the operation, but flights had to be halted for several hours because of torrential rains and hailstorms that added to the misery on the ground. Officials in the devastated areas of Pakistani Kashmir and North West Frontier Province said the quake, whose 7.6 magnitude made it the strongest to hit the region in a century, may have claimed up to 40,000 lives. A further 2,000 people are feared to have been killed across the border in Indian Kashmir.

Pakistani Prime Minister Shaukat Aziz told a news conference the confirmed toll so far in Pakistan was 23,000 dead and 51,000 injured, while India has confirmed slightly over 1,200 deaths. A senior UN official said helicopters had helped but rescue teams still had not been able to reach areas beyond the towns of Muzaffarabad and Balakot, in the Neelam Valley, or Chikothi and Jehlum because of landslides. ?Things are improving, but in the areas rescue teams have not yet been able to reach hope basically is fading,? said the official, who did not want to be identified.

?It?s getting close to 72 hours and for those who are not pulled out by tomorrow, the chances of survival are very much reduced.? Medical experts say an unhurt man can last three days without water and a woman four days, although in such disasters there are often extraordinary survival stories. Aziz said he was confident the situation would improve over the next days. ?They (helicopters) will fan out to villages outside the main cities so that the people receive relief there, in addition to the ground troops who are fanning out also, to go village to village and help out where needed,? he said.

<B>One million homeless</B>

UN officials estimate the quake has left up to a million people homeless and threatened by disease in Pakistani-run areas, and three million need assistance, many of them children. US officials said the US military was increasing humanitarian aid to Pakistan. President George W. Bush had offered an initial $ 50 million in US emergency aid to the close ally in its ?war on terror?.

The North Atlantic Treaty Organization (NATO) ambassadors in Brussels agreed to provide a small fleet of Boeing 707s to help move humanitarian aid to Pakistan. A NATO spokeswoman said the first aircraft with 7,5 tonnes of relief supplies would leave for Pakistan on Wednesday. Survivors from remote towns and villages said the only aid they had seen had been on television.

?There are dead bodies everywhere and those who are injured don?t have a drop of water,? said Nasar Ahmad, carrying his injured young niece on his back into Muzaffarabad, the devastated capital of Pakistani Kashmir. ?The main problem is food,? said Mohammad Altaf, who walked from Budman village to seek help. ?We?ve buried 250-300 people and hundreds more are still missing, buried under rubble.? Rescuers, many of them desperate relatives scrabbling with bare hands, have worked through the ruined houses in desperate hopes that they might be able to save trapped people.

There was some good news in the capital Islamabad when a 75-year-old Pakistani grandmother and her daughter were pulled from a collapsed apartment block after rescuers said they thought they heard sounds from seven different people. At least 40 people are thought still to be missing there, including European, Arab and Japanese nationals. ?It will take a long time because we have to work very hard and very carefully and try to reach those trapped through listening to their voices,? said Captain Jan Bohman, a spokesman for Swedish soldiers taking part in the rescue effort.

<B>Risk of disease</B>

The World Food Programme (WFP) said food was needed for at least a million people, but a first shipment sufficient to feed 240,000 for five days might not arrive until Wednesday. The problem will then be to get it to remote mountain districts. ?This food is needed urgently,? said WFP spokesman Amjad Jamal. ?People are trying to recover from a major disaster; they are in shock and their bodily resistance will go down if they do not have enough food.? Tens of thousands have been forced to camp out on chilly autumn nights, sometimes in driving rain, surrounded by decaying bodies and broken sewage systems.

The United Nations said there was a risk of cholera and pneumonia and Muzaffarabad?s health director Khawaja Shabir said malaria and other diseases were already breaking out, with hospitals wrecked and many doctors dead. ?We?re helpless in handling it on our own as right now we don?t have a single hospital left in Muzaffarabad, no medicine, no paramedic staff, nothing,? he said. On Tuesday the United Nations appealed for $ 272 million to provide tents set for winter, food, blankets, medicines, water purification equipment and to rebuild schools.

<B>Robert BIRSEL</B>